Coastal cities contrive to spread their transformative influence both into the hinterland, along the coastline, and into the coastal waters themselves. These effects will be intensified in urban agglomerations as the concentration of population and allied activities are more pronounced there compared to the inland regions. Indian coastal cities are no exception, and it is high time to delineate these hazard-prone regions and implement proper mitigation and adaptation strategies at city scale. This review article provides an assessment regarding quantification, management and climate change impacts of flood risks in Surat, Mumbai, Chennai and Kolkata, which are the most populated coastal cities in India. The flood impacts considered in the existing or prevailing analyses are associated with adverse effects on population, land use of cities, transportation and economy caused by different types of riverine and urban flooding, though coastal flooding, tsunami and storm surge effects are less studied. Mumbai and Kolkata are relatively progressive in the assessment of flood risks and adaptation. The present article also suggests strategies to evaluate the relative progress in the assessment of past and future risks and adaptation. We also discuss the mitigation and adaptation strategies considering the historical importance of these cities. We propose that the strategies should be implemented considering public opinion and should be initialized at the grass root level. Though it is technically difficult to re-plan the city structures in the current scenario, it is possible to adapt to and mitigate the effects of natural hazards through suitable planning and management with the integrated cooperation and involvement of citizens and government as well.